During the 2013 provincial election campaign the Liberals made three big health care promises. They were going to amalgamate nine district health authorities into one, improve wait times for hip and knee replacements and ensure a doctor for every Nova Scotian.<\/p>\n
Since any one would be hesitant to argue against the latter two planks, the promise about replacing the DHAs with a single authority drew most of the fire from their opponents. Pointing to problems that had come from Alberta\u2019s earlier move to a super board, the NDP predicted all sorts of chaos would ensue. But the amalgamation has happened and the NDP\u2019s predicted scenario has not taken place, at least so far.<\/p>\n
The other criticism levelled at the amalgamation promise was that the priority should be front line services, not reshuffling the health bureaucracy. That criticism has been borne out, in spades. The Liberal failure to make any progress on their other two key election promises is the evidence.\u00a0In fact, not only have the Liberals failed to make progress on family doctors and wait times, by some measures they\u2019ve gone backwards. In the case of family doctors, the evidence of regress is clear.<\/p>\n
Doc situation worse<\/strong><\/p>\n In 2013, when the Liberal platform promised \u201ca doctor for every Nova Scotian,\u201d Statistics Canada data show that about 9.1%, or 71,322 Nova Scotians aged 15 or older, were without a regular family physician.[1]<\/a> That was up more than 30% from 2011 \u2013 the kind of negative growth that makes excellent fodder for opposition politicians.<\/p>\n Last month Stats Can released data for 2015. Although not strictly comparable (it surveyed population 12 or older), it is clear the percentage of Nova Scotians without doctors has increased significantly \u2013 to 11.3% in 2015 from 9.1% in 2013. In actual numbers, after two years of Liberal efforts to ensure a doctor for everybody, there were about 23,000 more Nova Scotians without one. That\u2019s another 30% jump in two years. Broken promise #1.<\/p>\n Backsliding on wait times is a little harder to demonstrate. Last week the Canadian Institute for Health Information (CIHI) released one of its regular reports on wait times for five priority procedures, including hip and knee replacements. The report<\/a> received little or no coverage in the local media, perhaps because what it had to say on Nova Scotia was old news. Thanks to the media and the auditor-general (not to mention first-hand accounts) we\u2019ve become aware over the years that this province has a serious problem with wait times for certain procedures. Last week\u2019s report simply confirmed that.<\/p>\n It is perhaps less well known that when it comes to lengthy wait times for hip and knee replacements, this province is in a league of its own. That was the case in 2013 when just 50% of hip replacements and only 36% of knee replacements in Nova Scotia were being performed within the recommended wait time benchmark of 182 days \u2013 six months. The average for all provinces was 82% for hip replacements within the recommended time frame and 77% for knees.<\/p>\n Still worst by far\u00a0<\/strong><\/p>\n No other province approached Nova Scotia\u2019s record for futility in 2013, and that was still the case in 2016, when only 56% of hip replacements and 38% of knee replacements in Nova Scotia were being performed within the recommended time. The all-province average was 79% for hips and 73% for knees. The 2013 Liberal platform promised to \u201cmeet the national standard of six months for hip and knee replacement.\u201d Not even close: broken promise #2.<\/p>\n Granted, the Liberal campaign promise was an ambitious one. The target it set is one that no province is meeting \u2013 Ontario and Quebec were best in 2016 with over 80% of those procedures being done within the six-month standard. And to give the Liberals a bit of credit, Nova Scotia\u2019s 2016 result was a small improvement over 2013.<\/p>\n \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 2013<\/strong> \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 2016<\/strong><\/p>\n Hip replacement\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 50%\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 56%<\/p>\n Knee replacement \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a036% \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 38%<\/p>\n Hip % below average\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -32%\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -23%<\/p>\n Knee % below average\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -41%\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -35%<\/p>\n As the bottom four numbers show, for both hips and knees we are not as far short of the national average in 2016 as we were in 2013. We remained in a league of our own but \u2013 to continue the baseball metaphor \u2013 merely moved from peewee to bantam.<\/p>\n However, \u201cwe don\u2019t suck as badly as we used to\u201d is not an inspiring election slogan. And those modest gains for some on the wait list have been achieved at the expense of some others. CIHI has another metric, the 50\/90th<\/sup> percentile. It shows that in 2013, 10% of Nova Scotians were waiting 21 months or more for knee replacement and 18 months or more for hips. In 2016, wait times for those long-suffering (literally) groups were even longer – 25 months or more for knees and 20 months or more for hips. That\u2019s where the regression comes in.<\/p>\n The Liberals had better hope none of those folks show up on the TV news during the upcoming campaign. Their stories about waiting for two years or more would prove much more compelling than anything the Liberals might want to say about amalgamating health boards.<\/p>\n -30-<\/p>\n